Learning Objectives. What do you think? Upon completion of this module, you will be able to

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Learning Objectives

Upon completion of this module, you will be able to

Define Telehealth

Identify benefits of Telehealth

Recognize barriers to Telehealth, and

Summarize strategic drivers of Telehealth

What do you think?

1.

As our population ages, our

healthcare costs rise.

 True

 False

3.

Often, clients or their providers need to

travel to receive or deliver health

services.

 True

 False

2.

In Canada, waiting times to see a doctor

when sick or in need of medical attention

are similar to those in other developed

countries.

 True

 False

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What do you think? Answers

1.

As our population ages, our

healthcare costs rise.

3.

Often, clients or their

providers need to travel to

receive or deliver health

services.

2.

In Canada, waiting times

to see a doctor when sick

or in need of medical

attention are similar to

those in other developed

countries.

True. In our province, the average

annual healthcare dollars spent per person in the 45-64 age range is just over $2,300; it increases steadily to over $20,000 for those 85 years and older.

Currently, 15% of BC’s population is 65 years and older; by 2036, 25% will be over 65.

False. The 2005

Commonwealth Fund International Health Policy Survey of sicker adults found that Canadians experienced longer waiting times than patients in New Zealand, Germany, Australia, United Kingdom and the United States.

True. On Vancouver Island:

There were 881 visits by specialists to remote

communities in 2011 (Ministry of Health).

8% of Telehealth clients say they would not have received care if Telehealth wasn’t available (VIHA, 2011)..

Definition

Telehealth refers to the use of communication

and information technology to deliver health

care services and information over a distance.

Telehealth transmits voice, data, images and

information, avoiding travel for patients, health

providers and educators.

Telehealth is used to deliver

client consultations

, case conferencing, remote monitoring and

education

.

Examples:

 New and initial patient referrals

 Follow-up appointments

 Client and family visits

 Therapy or treatment sessions

 Pre-admission and discharge planning

 Triage decisions

Examples:

 Client health teaching and education

 Provider continuing education

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Telehealth Participants

Telehealth consultations involve

providers

and clients.

Telehealth consultations may require clinical support at

the client site to collect vital signs and assist with

examinations.

Telehealth enables collaboration among multiple

providers to discuss clients or share data and

information.

For example: physicians, nurses, therapists, and specialists.

Cardiologist, Nurse and Client participating in TeleCardiology

Examples of Telehealth

At a remote location

Psychiatrists provide psychiatric assessments.

Oncologists provide follow-up visits.

Perinatologists view live ultrasound images.

Heart specialists use a digital stethoscope to listen

to their client’s heart and lung sounds.

Dermatologists view live images of skin lesions.

Pharmacists review medications.

Pathologists examine slides and confirm diagnoses.

Speech Pathologists observe swallowing.

Opthalmologists view retinal images.

Client’s vitals are monitored at home.

TelePathology TeleHome Monitoring

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Strategic Drivers

There are

Limited access to health care providers due to

dispersed population and geographical diversity.

Higher mortality rates in some remote communities.

Higher emergency department visits per capita in

remote communities.

High proportion of elderly residents.

Increase in prevalence of chronic conditions

High cost and safety risks associated with travel for

physicians and clients.

History

19th Century

Telehealth can be traced to the mid 19th century when

electrocardiograph data was transmitted over telephone wires.

20th Century

In the mid 20th century, television and analogue picture transfer technology was adopted by psychiatrists to facilitate distant consultations.

1956

In 1956, Dr. Feindel, a Saskatoon neurosurgeon used a closed circuit television system to transmit live electrocorticography tracings.

1958

In 1958 Dr. Jurtras, a Montreal radiologist pioneered TeleRadiology.

2001

In 2001, Canada Health Infoway, a non profit Federal organization, contributed to the development of Telehealth in Canada.

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Telehealth Today

Telehealth is now available in all British Columbia health regions

supporting a variety of programs to many communities.

http://www.northernhealth.ca/

http://www.interiorhealth.ca/Y

ourCare/Telehealth/Pages/defa

ult.aspx

http://www.viha.ca/Telehealth

http://www.fnha.ca/

http://www.vch.ca/

http://www.fraserhealth.ca/

http://www.phsa.ca/AgenciesA

ndServices/Services/Telehealth/

default.htm

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For example:

 A provider and client converse.

 A provider listens to the client’s heartbeat with the help of a nurse at the client site.

 Multiple providers connect to discuss a client’s case. For example:

 A provider sends a dermatologist images of a client’s

skin lesions for later review.

 A psychiatrist reviews a video call of a client’s interaction with a case manager.

 A nurse and technologist capture and upload to a

central server several images of a client’s retina for remote opthalmologists to review.

Privacy and Security

In order to build effective client-provider relationships and meet British Columbia

legislation requirements privacy and security are secure. Telehealth uses secure

and encrypted pathways to ensure sessions are secure.

Telehealth

Meets Freedom of Information and Protection of Privacy Act (FIPPA)

standards.

Meets BC Ministry of Health privacy standards.

Has an approved Privacy Impact Assessment (PIA) and Security Threat Risk

Assessment (STRA).

Uses encryption and firewalls.

Allows secure connections provincially or out of province.

Live Interactive vs Store and Forward

Store and Forward is an asynchronous

modality where providers can review

images, information and data of the

client and respond at a

different time

based on the client’s need.

Live Interactive is a synchronous

modality that allows providers to see

and hear their clients in

real time

using Telehealth technologies.

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Telehealth Benefits

Increases service capacity and flexibility

Telehealth can enable

 Scheduling flexibility for providers and clients

 Regular follow-up.

 Providers to reach a larger geographical

area and client base.

 Better compliance for some clients. For

example, at Island Health some clients report that if Telehealth wasn’t an option, they would not have traveled for their appointment.

Improves access to health services

 Remote clients and providers can access health services and

education without leaving their community.

 Some clients are unable to travel due to health, family, financial or other reasons.

 Weather conditions and ferry schedules can impact a client or

physician’s ability to travel.

 Family can easily attend appointments and support their loved ones.

 Frequent appointments are more easily attended.

Client’s health can be monitored in their own home.

Enables early triage and treatment

In urgent cases where immediate medical intervention is critical, the use of Telehealth can

 Enable emergent triage allowing care to

begin immediately.

 Guide stabilization before transfers.

Prevent unnecessary transfers.

 Engage off-site specialists.

Examples include: TeleStroke, TeleBurn, and TeleICU.

Saves time and money

 Clients using Telehealth save expenses associated with travel such as

gas, hotel stays, flights, car rentals, child care, time off work, and ambulance transfers.

 Clients and providers don’t have to spend time travelling great

distances.

 Inclement weather conditions can make it unsafe for clients and

providers to travel.

Increases collaboration and learning opportunities

Telehealth

 Facilitates communication and relationship building among providers.

 Enables access to continuing medical education (for example CME

and rounds).

 Delivers program specific client education.

Reduces environmental impact

 Telehealth reduces the need for travel

and therefore prevents greenhouse gas emissions.

 For example, as of May 2013, Island

Health has avoided over 3.6 million kilometers of client travel, and has prevented over 977 tones of greenhouse gasses. This is comparable to parking 204 cars for an entire year!

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Economic

Telehealth requires

an infrastructure

investment of

resources and

technologies.

Cultural

Many factors

can influence a

person’s decision

to use Telehealth

Legal and Political

Telehealth may involve health

information exchange and

care provision within and

across jurisdictions. There is

a need for

Telehealth Challenges

.

Generational: the generation based

difference in technology, skill and use.

Education: the awareness of Telehealth and

its benefits.

Preference: the fit and feasibility

to integrate Telehealth into clinical workflow.

Trust in the Technology: the

reliability and consistency of the technology.

Ethnicity: the great

diversity in history, behaviors and traditions.

…common frameworks for credentialing among different jurisdictions and privileging amongst different hospitals.

…clarity regarding professional liability:

Doctor/ patient relationship, and

Malpractice and cross jurisdiction licensure.

…common frameworks for Physician reimbursement.

…clinical, operational, ethical and privacy guidelines for Telehealth practice. …governance structures and vision within healthcare to support Telehealth Securing funding for employment of

clinical and technical resources to design, deploy and operate Telehealth services.

Securing funding for the acquisition and implementation of technical

infrastructure for networks and other technologies.

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Summary

Telehealth uses technology to connect health care providers and clients over a distance.

Telehealth uses live interactive and store and forward modalities to deliver client care.

For both clients and providers, Telehealth reduces travel, saves time and money, allows

for early triage and treatment, and increases collaboration and learning opportunities.

Sometimes providers and clients are hesitant to adopt Telehealth due to economic,

cultural or legal/political reasons.

All health regions recognize Telehealth as a safe and useful way to deliver quality care

to far communities.

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Test your knowledge!

3. What is the definition of Telehealth?

a) The use of communication and

information technology to deliver

health care services and information

over a distance.

b) Using videoconferencing for business

meetings.

c) A telephone helpline service which

helps triage patient transfers.

4. Identify three benefits of Telehealth.

a) Saves time and money.

b) Replaces all in-person visits.

c) Increases collaboration and

learning opportunities.

d) Increases service capacity and

flexibility.

e) Reduces wait times.

2. Telehealth provided from BC Health

Regions:

g) Meets Freedom of Information and

Protection of Privacy Act Standards.

h) Uses encryption and firewalls.

i) Allows secure connections provincially

and out-of-province.

5. Please complete the sentence:

If a provider sends a dermatologist an

image of a client’s skin lesions for later

review, they have used a

____________________________

Telehealth modality.

1. What are some challenges of Telehealth?

a) Clients like travelling.

b) The lack of awareness of Telehealth and its benefits.

c) There is a need for common frameworks for credentialing.

d) Telehealth can only be used within each health region.

e) There is a lack of trust in the technology.

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Test your knowledge! Answers

1. What is the definition of Telehealth?

a) The use of communication and

information technology to deliver

health care services and

information over a distance.

b) Using videoconferencing for business

meetings.

c) A telephone helpline service which

helps triage patient transfers.

2. Identify three benefits of Telehealth.

a) Saves time and money.

b) Replaces all in-person visits.

c) Increases collaboration and

learning opportunities.

d) Increases service capacity and

flexibility.

e) Reduces wait times.

3. Telehealth provided from BC Health

Regions:

a) Meets Freedom of Information and

Protection of Privacy Act

Standards.

b) Uses encryption and firewalls.

c) Allows secure connections

provincially and out-of-province.

4. Please complete the sentence:

If a provider sends a dermatologist an

image of a client’s skin lesions for later

review, they have used a

Store and Forward OR Asynchronous

Telehealth modality.

5. What are some challenges of Telehealth?

a) Clients like travelling.

b) The lack of awareness of Telehealth and its benefits.

c) There is a need for common frameworks for credentialing.

d) Telehealth can only be used within each health region.

e) There is a lack of trust in the technology.

f) Telehealth doesn’t meet privacy standards.

Figure

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